Heavy episodic drinking, as defined by current guidelines, was associated with lower likelihood of receiving a preventive service in three out of four types of preventive care services we examined. Exceeding monthly, but not single-day limits was not associated with less preventive service receipt. There are several possible explanations. Persons with heavy episodic drinking are more likely to have diagnosable alcohol use disorders.40
Their lower likelihood of preventive services may be part of a constellation of behaviors reflecting self-neglect and/or impaired judgment. They may be difficult to engage, or their drinking may present competing demands that result in less clinical time for encouraging preventive care. Previous research found that heavier drinking was associated with fewer physician visits, offering less opportunity for preventive services.41
Alternatively, heavy episodic drinkers may have providers who focus less on preventive care.42
The lack of association between heavy episodic drinking and mammogram receipt is unique among the four services. Only nondrinkers were significantly less likely to receive the service than within-guidelines drinkers. The finding is somewhat puzzling, though consistent with some prior research.22
Although moderate (and heavy) drinking is a known risk factor for breast cancer, it seems unlikely that drinkers sought mammography because of this risk as it is not well publicized.43
Most analyses employing interaction terms did not indicate gender differences in the relationship between alcohol consumption and preventive service receipt. Certainly fewer women report heavy drinking than men.44,45
Further research is needed to confirm the role of older women’s drinking in preventive services use, and if confirmed, to understand why this might vary by service.
The effect of heavy episodic drinking was similar for services that are consistently recommended and that Medicare covers universally (influenza and pneumonia vaccinations), as well as for glaucoma screening, for which recommendations are mixed and Medicare covers only for high-risk groups. Thus, factors other than professional consensus and extent of coverage may drive the relationship between heavy episodic drinking and preventive service receipt. The relatively low preventive service use overall suggests that implementing multiple strategies to improve service delivery, as Medicare initiatives are aiming to do, is warranted.
The lack of significance found between over-monthly-limit drinking and receipt of preventive services may reflect a population at risk for chronic problems, but without current impairment affecting preventive services use. In contrast, heavy episodic drinking is more likely associated with at least acute cognitive impairment, which can lead to social disorganization and general self-neglect. This would be a fruitful area for further research.
This study has several limitations. The study’s cross-sectional design does not permit determination of causality. MCBS data are not ideally suited to precise dose-response analyses, which we therefore did not conduct. Other measures also carry some imprecision, including mental health variables: claims underestimate prevalence of mental health disorders, and self-reported depression is not synonymous with clinical disorder. The DxCG risk score is only a proxy for health status, but sensitivity analyses using self-reported health status did not change key findings (data not shown). Our analyses included glaucoma screening, a service not universally recommended. However, a similar pattern was observed across several measures. Finally, it is worth noting that study findings neither validate nor cast doubt on the alcohol guidelines, which were developed with a range of outcomes in mind, not health-care utilization.
The study goal was to examine the relationship between alcohol guideline adherence and preventive services receipt. Results suggest that elders with heavy episodic drinking are at risk for failure to receive certain recommended preventive services. Health-care providers and others working with older adults should be alert to the broad range of problems associated with unhealthy drinking and be encouraged to screen proactively all elders regarding alcohol consumption. Investigation of underlying causal mechanisms is needed. Nonetheless, currently recommended screening for unhealthy alcohol use could also identify those at risk for not receiving indicated preventive services, and interventions directed at lowering consumption might also improve preventive service use.